Surgery performed by Dr. Rubén Polo
Surgical resection of Acoustic neuroma, currently called vestibular schwannomaIt is a complex intervention of the lateral skull base surgerywhich requires a precise knowledge of the anatomy of the cerebellopontine angle and the internal auditory canal (IAC). In this article, we analyze in detail the surgery performed by the Dr. Ruben Polo, specialist in otoneurosurgery, available entirely in the app SurgSchool.
Introduction to vestibular schwannoma
Vestibular schwannoma is a benign tumor originating in the Schwann cells of the vestibular nerve (VIII cranial nerve). Its progressive growth can produce sensorineural hearing lossvertigo, tinnitus, and, in advanced cases, impairment of the Facial nerve, brainstem compression or hydrocephalus.
The surgical approach is indicated based on the tumor size, symptoms, patient age, and functional auditory status.
Indications for the translabyrinthine approach
El translabyrinthine approach It is a classic otological approach indicated when there is no useful preoperative hearing. Its main advantages are:
- Extensive exposure of cerebellopontine angle
- Direct and early control of Facial nerve
- Full access to I fell to the bottom
- Less cerebellar retraction
In surgery Dr. PoloThis approach allows for a safe, anatomical, and controlled resection of the tumor.
Technical description of the surgery
Following mastoidectomy and labyrinthectomy, the dura is opened and the cerebellopontine angle is exposed. The surgery progresses by:
- meticulous subarachnoid dissectionrespecting natural planes
- Progressive intracapsular emptyingreducing tumor volume to facilitate capsular dissection
- Early identification of critical structures:
- Facial nerve (VII cranial nerve), with continuous neurophysiological monitoring
- Cochlear and vestibular nerves
- Arteries of the angle, including branches of the AICA
The dissection alternates between lateral-medial and medial-lateral strategies depending on the tumor size, minimizing traction on the facial nerve.
Resection of the intrameatal component
A key step is the opening of the internal auditory canal, with precise dural incision and proper milling of its walls. This allows:
- To free the tumor from its apparent origin
- Complete tumor resection
- Confirm the anatomical and functional integrity of the facial nerve through direct stimulation
In this case, the The resection was complete, with a clearly identifiable facial separation plane.
CSF fistula closure and prevention
The closure is carried out with special attention to the prevention of complications:
- Obliteration of the angle with Abdominal fat in “hourglass”
- Sealing of the attic and mastoid cells with muscle, bone wax and hemostatics (Tachosil®, Surgicel®, Floseal®)
- Layered closure and compression bandage
These measures significantly reduce the risk of CSF fistula and rhinorrhea.
Educational value of this surgery in SurgSchool
This intervention constitutes a high-level teaching case, ideal for:
- Otorhinolaryngologists
- Skull base neurosurgeons
- Fellows and residents in otoneurosurgery
The video shows step-by-step intraoperative decision-making, the actual anatomy of the cerebellopontine angle, and the critical maneuvers for the preservation of the facial nerve.
